The evolution of the ventilatory ratio is a prognostic factor in mechanically ventilated COVID-19 ARDS patients

Background Mortality due to COVID-19 is high, especially in patients requiring mechanical ventilation. The purpose of the study is to investigate associations between mortality and variables measured during the first three days of mechanical ventilation in patients with COVID-19 intubated at ICU adm...

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Detalles Bibliográficos
Autores: Torres, Antoni, Motos, Anna, Riera, Jordi, Fernández-Barat, Laia, Ceccato, Adrian, Perez-Arnal, Raquel, Garcia-Gasulla, Dario, Penuelas, Oscar, Angel Lorente, Jose, Rodriguez, Alejandro, de Gonzalo-Calvo, David, Almansa, Raquel, Gabarrus, Albert, Menendez, Rosario, Bermejo-Martin, Jesos F., Ferrer, Ricard, Amaya Villar, Rosario, Anon, Jose M., Barbera, Carme, Barberan, Jose, Blandino Ortiz, Aaron, Bustamante-Munguira, Elena, Caballero, Jesus, Carbajales, Cristina, Carbonell, Nieves, Catalan-Gonzalez, Mercedes, Galban, Cristobal, Gumucio-Sanguino, Victor D., de la Torre, María Del Carmen, Díaz, Emili, Estella, Angel, Gallego, Elena, Garcia Garmendia, Jose Luis, Garnacho-Montero, Jose, Gomez, Jose M., Huerta, Arturo, Jorge Garcia, Ruth Noemi, Loza-Vazquez, Ana, Marin-Corral, Judith, Martínez de la Gándara, Amalia, Martinez Varela, Ignacio, Lopez Messa, Juan, Albaiceta, Guillermo M., andrea Novo, Mariana, Penasco, Yhivian, Carlos Pozo-Laderas, Juan, Ricart, Pilar, Salvador-Ade, Inmaculada, Sanchez-Miralles, Angel, Sancho Chinesta, Susana, Socias, Lorenzo, Solé-Violán, Jordi, Suares Sipmann, Fernando, Tamayo Lomas, Luis, Trenado, José, Barbe, Ferran, CIBERESUCICOVID Project Cov20 0011; ISCIII
Tipo de recurso: artículo
Fecha de publicación:2021
País:España
Institución:Conselleria de Salut i Consum del Govern de les Illes Balears
Repositorio:Docusalut
Idioma:inglés
OAI Identifier:oai:docusalut.com:20.500.13003/19856
Acceso en línea:https://hdl.handle.net/20.500.13003/19856
Access Level:acceso abierto
Palabra clave:Aged, 80 and over
Aged
Spain
Hospital Mortality
Critical Care
Humans
Middle Aged
Prognosis
Respiratory Distress Syndrome
Intensive Care Units
Male
Prospective Studies
Female
Respiration, Artificial
Cohort Studies
COVID-19
Ventilation-Perfusion Ratio
Pulmonary Ventilation
Retrospective Studies
Estudios de Cohortes
Femenino
Unidades de Cuidados Intensivos
Masculino
Humanos
Persona de Mediana Edad
Cuidados Críticos
Estudios Prospectivos
Síndrome de Dificultad Respiratoria
Pronóstico
Anciano
Mortalidad Hospitalaria
Anciano de 80 o más Años
Ventilación Pulmonar
Estudios Retrospectivos
Respiración Artificial
España
Relación Ventilacion-Perfusión
Ventilatory ratio
Mechanical ventilation
SARS-CoV-2
Coronavirus
Descripción
Sumario:Background Mortality due to COVID-19 is high, especially in patients requiring mechanical ventilation. The purpose of the study is to investigate associations between mortality and variables measured during the first three days of mechanical ventilation in patients with COVID-19 intubated at ICU admission. Methods Multicenter, observational, cohort study includes consecutive patients with COVID-19 admitted to 44 Spanish ICUs between February 25 and July 31, 2020, who required intubation at ICU admission and mechanical ventilation for more than three days. We collected demographic and clinical data prior to admission; information about clinical evolution at days 1 and 3 of mechanical ventilation; and outcomes. Results of the 2,095 patients with COVID-19 admitted to the ICU, 1,118 (53.3%) were intubated at day 1 and remained under mechanical ventilation at day three. From days 1 to 3, PaO2/FiO(2) increased from 115.6 [80.0-171.2] to 180.0 [135.4-227.9] mmHg and the ventilatory ratio from 1.73 [1.33-2.25] to 1.96 [1.61-2.40]. In-hospital mortality was 38.7%. A higher increase between ICU admission and day 3 in the ventilatory ratio (OR 1.04 [CI 1.01-1.07], p = 0.030) and creatinine levels (OR 1.05 [CI 1.01-1.09], p = 0.005) and a lower increase in platelet counts (OR 0.96 [CI 0.93-1.00], p = 0.037) were independently associated with a higher risk of death. No association between mortality and the PaO2/FiO(2) variation was observed (OR 0.99 [CI 0.95 to 1.02], p = 0.47). Conclusions Higher ventilatory ratio and its increase at day 3 is associated with mortality in patients with COVID-19 receiving mechanical ventilation at ICU admission. No association was found in the PaO2/FiO(2) variation.

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